Three cytokines, tumor necrosis factor (TNFalpha) and interleukin 1alpha and beta (IL-1alpha and beta), were studied for their relationship to alcoholic hepatitis. In a retrospective study of 23 patients with alcoholic hepatitis we found that elevated plasma levels of TNFalpha either at admission or discharge from the hospital were associated with death in 82% (14/17) of patients. In contrast, absence of elevated plasma TNFalpha was associated with survival in 100% (6/6). Plasma TNFalpha levels were also studied in alcoholic patients without clinically apparent liver disease, with alcoholic cirrhosis, or in nonalcoholic healthy controls and no elevated levels were found. Plasma IL-1alpha levels were also significantly increased in alcoholic hepatitis patients on admission and discharge whereas plasma IL-1beta levels were not. Neither IL-1alpha nor beta was correlated with outcome in the alcoholic hepatitis group. We have concluded that the presence of elevated plasma TNFalpha is a significant predictor of decreased long-term survival in patients with severe alcoholic hepatitis.